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Surgery - Burns || Burns criteria, Stages of burns, Rule of nine for burns , Burns Management — Transcript

by Dr.G Bhanu Prakash Animated Medical Videos · 18,125 words · 2,913 segments · language en · Watch on YouTube

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3:51hello
3:53as you started okay okay
3:56guys good evening
3:57welcome back to our Channel
4:03hello everyone
4:04please let me know whether I am audible
4:07or not
4:38okay
4:52fine
4:54please give some thumbs up or something
4:56so that I can know that I am Audible and
4:58there is no issue with the video as well
5:14okay
5:15so yesterday we had to talk about the
5:17drama right
5:20and
5:22today we'll be discussing about the
5:24burns actually so again guys Burns is a
5:27very important topic as we know that uh
5:31you know a lot of patients are coming in
5:32the trauma unit but the main thing over
5:35here is that all of the burn patients
5:38cannot be treated in the emergency room
5:40only there are some patients who should
5:43be transported to the spatial Burn
5:45Center and there they will be getting
5:48their treatment according to their
5:50protocols right so
5:53yeah
5:54okay
6:04fine
6:05so guys before we discuss about the
6:07bonds okay we would like to you know
6:10revise the trauma right with the help of
6:13some mcqs
6:16okay
6:17so
6:22right
6:27okay
6:30so here is the first question guys
6:32please try to answer this uh very basic
6:35one the minimum score
6:38in GCS
6:48right
6:52minimum score in GCS
6:54anyone
7:01the options are there one two three four
7:35okay
7:39the options are one two three and four
7:42if these are the options what should be
7:44the answer guys
7:52okay
7:53meanwhile I'm writing the next one
8:00the next question is
8:02um
8:04if the patient is having according to
8:06GCS
8:09right the patient
8:11is having the Glasgow comma scale
8:15I would say the verbal response
8:16according to the GCS is one
8:23okay so what should be
8:26what should be the
8:28answer in this case
8:31fine I'm just writing the options
8:32options are
8:39inappropriate words
8:46confusion
8:49no response
8:53or
8:58only the sounds
9:00okay or the mumbling
9:08right
9:15okay
9:19potential of answer for the first
9:20question is
9:22this should be the three I told you the
9:24maximum score in the GCS would be 15 and
9:28the minimum score in the GCS would be
9:313 okay and over here the maximum
9:36here they told you verbal response in
9:38the patient is one actually so in this
9:40case
9:42in any case if they're asking if if the
9:45motor response is one or if the verbal
9:46response is one or if the IG response is
9:49one then in that case your answer would
9:50be no response
9:53okay so that is the minimum score that
9:55you can give over here
9:57fine
9:58okay so now I'm going uh into the
10:01Burns okay so we'll try to discuss some
10:04main concepts of the bones right so
10:07let's talk about the burns now
10:12ok
10:13so in the ones okay so in the last one
10:15uh in the yesterday session we had to
10:17talk about the uh trauma right and in
10:20the today's one we are gonna discuss
10:22about the burns actually so let's assume
10:26that you are a doctor in the casualty or
10:28the emergency so over there the patient
10:30comes to you right and let's say now
10:34this is the burn patient right so how
10:37will you handle this these kind of
10:38patients right so we'll be talking about
10:40the degrees of the burn the stages of
10:42the burns okay and how to manage these
10:44kind of patients further but uh this is
10:47the basic one that how
10:49if the patient how the patient should be
10:51treated if the patient burn patient
10:52comes to your trauma unit right so in
10:55this case first of all we are having a
10:57very important criteria that whether
10:59according to this criteria whether this
11:02patient should be treated in the
11:03emergency room only or we should
11:05transport this patient or we should send
11:07this patient to the specialized Burn
11:09Center so that is the first question
11:10over here so over here according to the
11:13American
11:14bonds Association criteria
11:17okay they have actually made the
11:19criteria for the burn center referral
11:21right so which patients are actually uh
11:25you know suited for the referral of the
11:28patient in the burns unit so these are
11:30some criteria over here sometimes they
11:31ask you a question that which of the
11:33following is not the criteria according
11:35to American birth Association criteria
11:37for the reference so guys here are some
11:40important points over here for example
11:44Burns to the if the patient is coming to
11:46your trauma unit okay and the patient is
11:48having burns to the face hands and feet
11:50okay and the major joint genitalia
11:53perineum these are involved then you
11:55should better transport this patient to
11:57the specialized Burn Unit right then if
12:00the childrens are coming with children's
12:03uh in the healthcare facilities the
12:06staff is not trained much to handle that
12:09children if the burned patient is coming
12:12over there okay so in that case also we
12:15need to refer this patient to the
12:16specialized Burn Unit now if the
12:18concurrent trauma is there electrical or
12:20chemical burns should be handled by the
12:22specialized Burn Unit then the full
12:24thickness Burns or the third degree
12:27burns at any age okay the full thickness
12:30Burns they are usually the third and
12:31fourth degree burns they should be
12:33treated in the specialized Burns unit
12:34Okay then if the greater than total
12:38ah body surface area is more than 10
12:40percent right then also inhalational
12:43injuries and then patients who need the
12:46specialized emotional or the
12:48rehabilitation support they should be
12:50transported to the uh you know Burn
12:52Center
12:54now if you are talking about uh the
12:57burns over here first criteria is the
13:00American burn Association criteria now
13:02the next thing over here is that if the
13:04patient comes to you
13:05so you need to give the basic treatment
13:07to this particular patient now as we
13:10have discussed yesterday in the trauma
13:13section that first of all we need to
13:15look for the primary survey I told you
13:17according to the atls guidelines we need
13:19to do the primary survey and the
13:20secondary survey right later on
13:21secondary survey so
13:23here also we need to actually go for the
13:27according to the atls guidelines what
13:29they say is that you know in the burns
13:31also we are talking about the ABCD so in
13:34the burns also we are going to talk
13:35about the ABCD so a for again Airways
13:40right B for breathing
13:44Okay C for
13:46circulation
13:49and D for disability
13:53right T for disability now over here
13:56Airways breathing circulation and
13:57disability so first of all let me talk
13:59about the Airways that how if the
14:01patient is coming you need to secure the
14:03Airways right in which patient you need
14:05to secure the Airways that is the
14:06question right same like we have
14:08discussed in the trauma on trauma also
14:10so first of all we are gonna discuss the
14:14Airway
14:23okay so in the airway section first of
14:25all we need to see that if there are
14:27some injuries regarding the air base
14:29right for example uh there could be some
14:31injury which could have burned the nasal
14:34hairs right some inhalational injuries
14:36can be there for example some person uh
14:38was in the uh you know burning burning
14:42area and he could have you know inhered
14:45the very hot gases very hot smoke right
14:48so due to that the nasal hairs could
14:50have been burned right so those kind of
14:52inhalational injuries can be there so if
14:55in in case
14:58in case if the patient is having
15:00inhalational injuries
15:06inhalational injuries
15:08then we might need to do some action
15:11over here we not we we need to take some
15:13action and that would be the uh
15:15intubation so intubation we are doing in
15:17this patient for the prophylaxis purpose
15:19only okay I'm coming to this section
15:21second thing so we need to look for the
15:23inhalational injuries in the patient
15:24right we need to look for any
15:28burned nasal layers okay
15:31look into the nasal cavity and look for
15:34the burning area burning areas in the
15:37nasal cavity region okay so third thing
15:40over here is that you need to check for
15:42the voice okay try to communicate with
15:45the patient and if the patient voices
15:48having the hoarseness then also it is a
15:50danger sign for the airway section
15:53the next point over here is that
15:55you know if the patient is having
16:00deposits in the sputum
16:02right
16:03deposits in the sputum this is also the
16:07danger sign as far as Airways are
16:09concerned right next point over here is
16:11that if the burn is actually involving
16:13this area that is the head area neck
16:15area right so head and neck area face
16:18area Okay this this area if it is
16:20involved then uh you know this is the
16:22danger sign for the airway and you need
16:24to secure the Airways in these kind of
16:26patients okay by the help of intubation
16:28so if the head neck or face area is
16:31involved and neck or face
16:36is involved
16:37in the burn bones so in this case also
16:41we need to actually uh you know look for
16:44the prophylactic intubation to secure
16:47the Airways in these patients right so
16:49these are some of the uh basic things
16:52which we need to look into the patient
16:54for the evaluation of the airway section
16:57so if any of these things are present
16:59then if any of these things are present
17:01then what you need to do is you need to
17:03do the prophylactic intubation
17:07okay so what you will be doing you will
17:09be doing the Prof for lactic intubation
17:11okay why we are doing the prophylactic
17:14intubation let us say the patient is
17:16having any of any one of these things
17:18among the Airways section and person is
17:21breathing you know normally okay but
17:23still you need to secure the Airways by
17:25the help of prophylactic intubation why
17:28is it so because later on this same
17:30patient might develop the laryngeal
17:32edema okay and when the patient will
17:34develop the laryngeal edema obviously
17:36the patient will not be able to speak
17:37and second thing is then at that time if
17:40you will try to intubate the patient you
17:42will not be able to do so because at
17:44that time the intubation will become
17:45very difficult right so that's why I'm
17:49using the word prophylactic so
17:51prophylactic intubation should be done
17:52in these cases why because later same
17:56patients might develop the laryngeal
17:57edema right so why we are doing doing
18:00the prophylactic intubation because
18:02later the patient might develop
18:05patient might develop
18:11laryngeal edema
18:14Behringer Adam right okay no problem now
18:20let's say this patient okay any of the
18:24signs are present you did the
18:25prophylactic intubation let's say uh you
18:27know the patient came late to the trauma
18:29unit okay and already the laryngeal
18:31edema have been happened now in this
18:34case you are trying to intubate the
18:36patient but because of laryngeal edema
18:38the intubation intubation cannot be done
18:40so in this case what you will be doing
18:42is you should be ready with the needle
18:44cricothyroid dot me which I told you in
18:47the yesterday's session also that needle
18:50cricothia.me you will be inserting into
18:51the cricket membrane okay the needle 14
18:54gauge needle should be inserted in the
18:55in in the cricothyroid membrane so in
18:58those cases you might be doing
19:03needle
19:05trichothermic
19:11right needle cricothyroid Atomic okay
19:13fine
19:15so obviously if it fails if it fails if
19:19the intubation fails right if your
19:21intubation phase then you have the
19:23option of needle cricothyroidotomy
19:25fine okay
19:27okay now if some patient come if some
19:29patient is coming okay but these kind of
19:31signs are not present but this patient
19:33is having the
19:35uh you know burn area more than 40
19:38percent so more than 40 total body
19:41surface area I will talk about the you
19:43know how we calculate the total body
19:45surface area so if more than 40 total
19:47body surface area is involved in the
19:49patient then also we need to do the
19:51prophylactic intubation right so
19:55let's say that if more than 40 percent
19:59total body surface area
20:01is burnt
20:03right then also we need to do the
20:07prophylactic intubation
20:10prophylactic intubation right
20:13so keep this in mind
20:16ok
20:17so this section is clear now next thing
20:19is if the Airways are burned right so in
20:23this case what are the phases there are
20:25three phases overall uh which can be
20:27seen in the patient as signs and
20:28symptoms so these phases are first phase
20:31over there is
20:36right in the first phase you can be
20:38seeing that you know in the airway
20:40section there could be acute pulmonary
20:42insufficiency so patient saturation will
20:44be very low the patient will be having
20:46the breathlessness so patient will not
20:47be able to breathe properly so these are
20:49the things which you can see in this
20:51particular phase so in the phase one we
20:53can talk about the
20:55breathlessness
20:58in the phase one we can talk about the
21:00breathlessness and the patient
21:01saturation might fall in these kind of
21:03cases okay and what we are calling this
21:05as we are calling this as acute
21:07pulmonary insufficiency
21:09acute
21:11pulmonary insufficiency that is the
21:14first phase
21:16of the Airways Burns right second thing
21:19over here is
21:22second phase is the phase two in the
21:24phase two the patient will be having the
21:29acute respiratory distress syndrome like
21:31picture so patient will be having the
21:33ards like picture
21:36ards like picture in the X-ray of the
21:38patient
21:40right so the lungs will be having the
21:43pulmonary bilaterally pulmonary
21:45infiltrates okay so if you will be
21:47seeing the accident of these patients so
21:49you will be finding the bilateral
21:50pulmonary infiltrates
21:54okay bilateral pulmonary infiltrates now
21:58page one is done two after that phase
22:01three might be seen in this kind of
22:03patient in some patients in the phase 3
22:05we are talking about
22:08the pneumonia so the pneumonia might
22:10develop in the lungs okay and obviously
22:12this is the late stage
22:14so in the phase three we might see the
22:16Broncho pneumonia
22:19Bronco pneumonia in these kind of cases
22:22the patient may have you know the
22:25epithelial damage inside the lungs so
22:27epithelium might get damaged over there
22:29so you know we are having in this
22:31particular phase only early stage and
22:33the late stage can be there in the early
22:35stage we are talking about the bacteria
22:37development that is usually the
22:39staphylococcus so in the early stage
22:41staphylococcus bacteria is developing in
22:43the later stages gram negative bacteria
22:45might develop in this case because we
22:46are talking about the pneumonia right so
22:49in these cases
22:54What Might Have Been happened that
22:57in the early stage
23:02staff warriors might develop
23:06right and in the late stage
23:09in the late stage the patient might
23:12develop the
23:13gram negative bacteria
23:16okay gram negative bacteria so this is
23:19also very important now next point over
23:21here is if the Airways you have actually
23:23secured the Airways let's say the
23:25patient came to your trauma unit and any
23:28of those signs were present which we are
23:29talked about then you secure the Airways
23:31you did the prophylactic intubation
23:33after that after the Airways are secured
23:35you need to look for the breathing
23:36section A B C D right so in the
23:38breathing section what you will be
23:39looking look for the hypoxia component
23:41in the patient so in the breathing
23:43section what you will be looking
23:46okay so second one is the breathing
23:48section so Airways are done
23:51now the breathing section okay so in the
23:54breathing section we'll be looking for
23:58okay so in the breathing section we will
24:00be looking for if the patient is having
24:02hypoxia
24:05right if the patient is having hypoxia
24:06or if the patient is having let's say
24:08the patient uh was in the closed room
24:11and in the closed room there was burned
24:13okay and that trauma happened over there
24:15so if that patient is coming to you
24:18obviously if the burn
24:20uh if you know the smoke if the bond is
24:23there in the closed room obviously the
24:25smoke will be emitting out from there so
24:27that smoke person will be inhaling again
24:28and again and due to that inhalation of
24:30smoke what what could have been happened
24:32carbon monoxide poisoning can be seen in
24:34these patients
24:36carbon monoxide poisoning can be seen in
24:39these patients and then
24:41in some patients if the burns are very
24:44very severe in those cases they might
24:46develop the
24:48as Shear formation
24:50and now what is this Sr formation over
24:53here now look at this picture
24:55okay here you can see the bonds are so
24:58severe then they might develop the this
25:00kind of picture that is the texture
25:02formation okay now sometimes we need to
25:05actually cut this Ester okay for example
25:07if those if this area was actually
25:10exposed to the burns so in this area
25:12also the Azure formation might have been
25:14happened so in this case what we'll do
25:16is sometimes the plastic solution they
25:19will be doing the astronomy right so
25:22astronomy might be done in those cases
25:23because if the acid formation is present
25:26in this particular area in the in the
25:28chest area then or in the thoracic area
25:31then what could have been happened this
25:33will restrict the breathing right the
25:35person will not be able to breathe
25:36properly so that's why astronautomi can
25:38be might be done in those kind of cases
25:41right so it can cause a respiratory
25:43compromise
25:44right
25:45so after checking for the breathing
25:47component we need to look for the
25:49circulation component
25:51so Airways are done breathing is done
25:53and then we should look for the
25:55circulation component in the circulation
25:57component we are talking about the
26:00response from the body side right so
26:02what is the response from the body
26:04against the burns right the burns happen
26:07to the patient what how the body will be
26:09reacting against this kind of process so
26:12over here we are talking generally we
26:14are talking about the inflammatory
26:16response
26:19and this inflammatory response is
26:21actually depending on the extent of the
26:24burn that how severe the burn is
26:26accordingly inflammatory response will
26:28be seen in the patients so it is
26:29directly proportional to the extent of
26:31bone
26:33right if the extent of bond will be more
26:35if the bonds will be more obviously if
26:37they are covering more area then
26:38obviously the inflammatory response will
26:40also be much stronger so if I'm talking
26:43about inflammatory response what
26:45basically I'm talking about okay what
26:47exactly I am talking about if I am
26:49saying that inflammatory response what
26:50do I mean by that okay before coming to
26:52that if the if the patient is having
26:55less than 10 percent body surface area
26:57Bond less than ten percent total body
27:00surface area okay if the bonds are
27:02involved less than 10 percent total body
27:04surface area then we are saying that the
27:06patient will be having localized
27:09immune response the patient will be
27:11having
27:12localized
27:14inflammatory response
27:18localized inflammatory response if the
27:20patient is having
27:22more than
27:2410 percent total body surface area if
27:26the patient
27:28total body surface area
27:30has been burned more than 10 then in
27:32those cases generalized or I would say
27:35systemic inflammatory response so
27:37generalized inflammatory response will
27:39be activated
27:41generalized inflammatory response would
27:44be seen in such fictions so guys now uh
27:48the circulation part is very very
27:49important because these kind of patient
27:51might have the evaporation from the body
27:53and due to that evaporation the patient
27:55might be having severe dehydration and
27:56due to that person might be going into
27:58the shock
27:59right so this is very important to know
28:01that how this inflammatory response is
28:03actually working in the body so if
28:06obviously uh looking over here you can
28:08see that if the more than 10 percent
28:09area is actually involved then
28:11generalized inflammatory response can be
28:13there or if it is less than 10 then only
28:15the local portion is actually getting
28:17involved
28:18so over here what happens is let's say
28:20the burn patient comes right
28:22in this patient there was Burns right
28:25this will actually activate the
28:27inflammatory response
28:30this will activate the inflammatory
28:31response
28:32if more burn area will be involved more
28:35inflammatory response will be there
28:37due to the activation of this
28:38inflammatory response it will cause the
28:40vasodilation
28:43it will be causing the Vaso dilation
28:46right and if the vasodilation will be
28:48happening what will happen
28:50okay what will happen actually then you
28:54know whatever component is present
28:55inside the blood vessel it might leak
28:57out from the blood pressure right I'm
28:59saying let's say this is the blood
29:00vessel
29:01right
29:02let's say this is the blood vessel okay
29:06and what is happening uh the
29:09inflammatory response has been activated
29:11right usually it is activated by the
29:13inflammatory mediators usually it is
29:15activated by the inflammatory mediators
29:17what mediators we are talking about
29:19mediators like stamina is there
29:22prostaglandins or leukotriines okay
29:24these are the inflammatory mediators
29:25right so these inflammatory mediators
29:27will be causing the vasodilation in the
29:29blood vessel as the vessel dilation will
29:31happen whatever content is present
29:33inside the blood vessel it will try to
29:35leak out into the third space actually
29:38with the vasodilation the capillaries
29:40are also becoming leaky
29:42right
29:43so the capillaries are also becoming
29:45leaky
29:47capillaries are become leaky over here
29:49so they will be losing their content so
29:52blood vessel will be losing their
29:53content so what could have been happened
29:55over here is that
29:58this patient
30:01blood vessel became leaky so whatever
30:03content is present inside
30:05okay whatever content is present inside
30:07okay
30:09this will
30:10start to leak out from this capillary
30:13well fine it will start to leak out from
30:16the capillary and as the content will be
30:18leaking leaking out from the capillary
30:19what will happen the patient might be
30:22losing the fluid from the body okay it
30:24will be accumulating in the third space
30:26so edema will be seen in these patients
30:28but the patient might go into the shock
30:30right so that is the idea that's why the
30:33vasodilation can vasodilation can cause
30:35the shock in the patient so basically uh
30:38you know one more component one more
30:39very important component is actually
30:41leaking out from the capillary and that
30:43important component is the colloid that
30:46is your protein and very basically which
30:48protein I'm talking about that is the
30:49albumin protein so
30:52again guys there was a burn patient
30:54right inflammatory response might have
30:56been activated in this patient in this
30:58patient inflammatory mediators which are
31:00like histamine liquid transplantings
31:02right these kind of mediators what they
31:05did is they did the vasodilation in the
31:07blood vessel after doing the
31:08vasodilation
31:10with that the capillaries will become
31:12leaky and if the capillaries will become
31:15leaky mainly the albumins and the fluid
31:18right the albumin will be leaking out
31:20and albumin is actually holding the
31:23fluid inside the blood vessel right
31:25because of the oncotic pressure right or
31:28choleroid osmotic pressure if the
31:30albumin will be lost from the blood
31:32vessel then fluid will also be lost from
31:35the blood vessel and due to that the
31:37patients might be having the dehydration
31:39right so due to the capillary because
31:41the capillary is becoming leaky what
31:43will happen is
31:45that these kind of patients will be
31:47losing the
31:49albumin right so
31:52albumin will be lost
31:56right as the albumin will be lost in
31:58these patients the patient will be
32:00losing the fluid also right so the fluid
32:04will go into the fluid will go into the
32:06third space
32:09fluid will go into the third space
32:13okay or you can say the extra vascular
32:15space okay or you can say it will go
32:17into the extra vascular space
32:22right
32:24okay then what will happen now imagine
32:26this is the blood vessel guys in the
32:28blood vessel there was a lot of albumin
32:30and fluid right albumin the now the
32:33blood vessels have become leaky right
32:35the blood vessels have become leaky and
32:38now the album will be lost from these
32:40blood vessels if the albumin will be
32:42lost from these blood vessels then fluid
32:44will also be lost on the blood vessels
32:46and now this is the extra vascular space
32:48now in this extravascular space the
32:51albumin will be coming and the fluid
32:54will be losing in the fluid will be
32:56coming out in the extra vascular space
32:58that is also called as the third space
32:59so usually we are saying third space
33:01loss will be seen in this patient right
33:03obviously if the fluid is actually
33:05getting lost from these blood vessels
33:08then obviously the fluid volume is
33:11decreasing in the in these kind of
33:12patients right and that's how the blood
33:14pressure will also be dropping the
33:16patient might go into the shock with
33:18that we can say the patient will be
33:19having severe dehydration right
33:22due to that due to the vasodilation the
33:24patient will be having the evaporation
33:26and that is also the factor uh because
33:30of which the patient might go into the
33:32shock
33:33okay so that is basic pathophysiology
33:36behind the shock in the burns patient
33:39okay
33:41so that is the thing over here so that's
33:43how the patient might be having the
33:44evaporation due to the vasodilation the
33:46patient might be having the evaporation
33:48also
33:51okay and because the fluid is getting
33:53lost into the third space due to that we
33:55can say the patient will be having the
33:56dehydration
34:00right so that is the pathophysiology
34:02behind the shock in the cases of burns
34:06patient right so that is very important
34:08okay once we have talked about this
34:10particular process then we can talk
34:12about the treatment part right treatment
34:15part means if the patient is having
34:16shock right obviously what you are
34:18giving usually what comes in your mind
34:20if you are thinking about the shock
34:21patient root volume is lost so you are
34:24thinking about giving the fluids to this
34:25patient right obviously again same thing
34:28I told you yesterday also right can you
34:31let the patient on both the sides
34:32minimum 18 gauge cannula start the
34:34fluids right start the fluids now over
34:37here the cash point is whether you will
34:39give which fluid you will be giving
34:41basically so we are giving the
34:42crystalloids in crystalloids what you
34:44are giving shall I give normal saline
34:46into this patient or should I give uh
34:49dextrose to this patient should I give a
34:51ringer lactate to this patient so answer
34:53to this question is we should be giving
34:55the ringer lactate to this patient which
34:56is also called as the Hartman solution
34:58okay now why is it so we'll talk about
35:01this so guys what is the management
35:03okay so the management for such cases we
35:08saw that there was dehydration
35:09evaporation the patient might be in the
35:10shock right patient BP will be checking
35:12the vitals of the patient obviously
35:13patient came to your trauma unit so you
35:15will be checking the virus obviously BB
35:17will be on the lower side because of
35:19this pathophysiology and you will now
35:21thinking about the uh you know how to
35:24overcome this particular shock
35:26so in these cases you will be thinking
35:27of giving the fluids which fluid I told
35:29you ringer elected or RL which is also
35:31called as the Hartman solution you will
35:33be giving to these patients now
35:36if you are giving the IV fluids
35:39right you are thinking to give the IV
35:42fluids
35:43right so the most uh
35:46most ideal IV fluid in these Burns
35:49patient would be the ringer lactate okay
35:51would be the ringer
35:54lactate
35:57this is also called as the art main
35:59solution
36:00right
36:04ottoman
36:05population right you can see over here
36:07the packet of the ringer lactate if you
36:10will see you know if you are working in
36:12the uh in any kind of Hospital right
36:14very commonly you can ah find this in
36:16the emergency or in the world or
36:18anywhere in the hospital you can easily
36:20find this ringer lactate bottle okay
36:22very commonly the patients are actually
36:24uh taking this right we are giving the
36:26fluids to the to the patients so this is
36:29the uh RL okay you can see 500 mL so
36:33what you can see over here is that what
36:36is the content of the ringer lactate
36:37okay that's why I'm showing you this and
36:39in the uh in today's examinations okay
36:41they are just giving you the photos okay
36:43and you need to identify which what kind
36:45of fluid they are talking about is it
36:47normal saline or is it dextrose like
36:48that so ringer lactate is containing you
36:51can see the sodium chloride
36:53okay you can see the sodium chloride the
36:57lactic acid okay the potassium chloride
36:59and the calcium chloride in water okay
37:02in water it is containing the uh KCl
37:06which is the potassium chloride calcium
37:07chloride and it is containing the
37:09lactate right so this is the solution
37:12right and sodium lactate so this is the
37:14solution for the linger lactate now why
37:16we are giving this in the bones patient
37:18because in the bones patient there is a
37:19tendency for the metabolic acidosis and
37:22ringer lactate helps us in treating the
37:25metabolic acidosis also so that's why
37:27because it prevents the metabolic
37:29acidosis that's why it is the ideal IV
37:32fluid choice in the burns patient okay
37:34so we can overcome the dehydration part
37:36also and we can overcome the metabolic
37:39acidosis part as well at the same time
37:41right so that is the motto behind giving
37:43the RL fluid or the Hartmann solution in
37:46the burns patient right okay so once we
37:48are clear with this
37:51right once we are clear with this let's
37:52move forward and if the patient is
37:54coming okay uh one more thing with the
37:56IV fluids we can give the uh Collide
37:58also because I told you albumin is
38:00getting lost from the blood pressure so
38:02you might be thinking that albumin we
38:03can give the albumin also right or
38:06albumin is actually the Collard only
38:08okay four point five percent albumin is
38:10a cold only
38:12so
38:13can we give shall we give Collard in
38:15this patient yes we can give colloid in
38:16the patient but not in the initial 12
38:19hours
38:20right because in the initial 12 hours of
38:23the burns right the patient will be
38:26losing the patient's blood capillaries
38:27will be losing the albumin very
38:30very quickly so that's why if you are
38:33giving the albumin to this patient in
38:35the first 12 hours only then whatever
38:37albumin you will give it will be leaking
38:39out from the blood capillaries right
38:40what I am saying is I told you guys that
38:43over here what I told you that whatever
38:45albumin let's say this was albumin right
38:47this was albumin whatever albumin you
38:49were giving it was coming outside right
38:51so in the first 12 hours if you are
38:54giving in the first
38:55in the first 12 hours if you are giving
38:57the albumin to this patient same story
38:59will be happening to your albumin also
39:01it will come in the blood vessel and it
39:02will be leaking out it will come in the
39:04blood vessel and it will be leaking out
39:06so there is no benefit in giving this
39:07colloid or albumin to this patient so
39:09that's why don't give the colloid for
39:12the first 12 hours okay after the 12
39:15hours you can start with the collared
39:17also right so initially we are giving
39:19the ringer lactate only after the 12
39:21hours you can
39:22start the colloid also right because
39:25this process will be slowing down after
39:2712 hours right okay understood so IV
39:29fluids you can give the colloids also
39:32Point second you can give the colloids
39:36right which is
39:374.5 percent
39:42but the catch point over here is
39:46not
39:49in the initial 12 hours not in the
39:53initial values okay please remember this
39:55very important point and this point has
39:58been asked in the questions also many
40:00times right now once we are done with
40:03this let's say the patient is coming to
40:05your trauma unit okay so I told you
40:07first thing is less than total less than
40:09uh 10 total body surface area is
40:11involved one patient is there second
40:12patient is there more than 10 percent
40:14total body surface area is involved
40:15right okay
40:18now inflammatory response I told you how
40:20it is working how it is causing the
40:21dehydration and how is it causing the
40:23evaporation and how how it might cause
40:26the shock in the patients which fluid we
40:28should you should be giving that that
40:30also I told you now if in the children
40:33the patient is coming with the more than
40:3610 percent bones okay so what I'm saying
40:39is
40:41if
40:43the child comes to your trauma unit more
40:45with more than total body surface area
40:4710 percent okay in child I'm saying
40:51right and
40:54one more adult came now
40:57and in this adult more than 15 total
41:00body surface area is involved so in
41:03these cases
41:06you will be saying that in these cases
41:07the patient might develop the
41:09hypovolemic shock okay a patient might
41:12develop the hypovolemic
41:15talk
41:16now initially in the burns patient the
41:19patients will be having the hypovolemic
41:20shock later on these patients might
41:22develop the septic shock I will I will
41:24tell you the causes of death in the
41:26burns patient also so always remember
41:28that dehydration is a very important
41:31portion and we need to treat the
41:32dehydration we need to give the fluids
41:34in the bones patient that is very very
41:36important and it depends on how much
41:39body surface area has been burned in the
41:41patients right
41:43okay so in case if
41:49more than 10 team total body surface
41:51area in child and more than fifteen
41:52percent in adult that will be considered
41:54as the that might be saying that the
41:56patient might be having the hypovolemic
41:58shock
41:59now how will you do the fluid management
42:02okay what fluid we are giving we have
42:04understood that how will be doing the
42:06fluid Management in the patients
42:10right fluid management
42:13right so in for the fluid management we
42:16are having some ah formula over there
42:18but before that let's say if the patient
42:20is there and they are having the small
42:22area of Burn only
42:24small area of burn
42:27another patient is having the more more
42:29area of one large area Bond let us say
42:31more than 10 to
42:3315 percent total body surface area Bond
42:36okay how will you manage these patients
42:39so if the patient is having small area
42:40Burn only then you'll be you might give
42:42them oral Foods also right you might
42:45give them oral fluids but the main thing
42:48over here is please mix the salt in it
42:52because during the evaporation they
42:54might lose the salt also so that's why
42:56oral flutes we are giving but mixing the
42:58salt in it and that hypertonic solution
43:01you can give to the patient if the
43:03patient is having minor burns right
43:05small area bonds but if the patient is
43:07having more than 10 to 15 total body
43:09surface area Burns then in those cases
43:11you must give the IV fluids
43:14in those cases you must give the IV
43:16fluids and how you are giving the IV
43:19fluids we are giving them according to
43:22a very important formula very famous one
43:25very popular one that is the Parkland
43:27formula
43:30right according to the Parkland formula
43:32now what is the Parkland formula
43:35okay let's talk about that as well what
43:36is the
43:37Auckland formula and what it says
43:40in mcqs it is tested very very commonly
43:43so please listen to this section very
43:45very uh
43:48very very diligently now look over here
43:51in the parking formula we are saying
43:53that
43:54according to this formula we can
43:56calculate how much IV crew should be
43:57given so 2 into
44:00body weight of the patient in kg
44:03body weight of the patient in kgs into
44:06total body surface area
44:09which is burnt
44:12so this is the formula
44:16okay this is the Parkland formula
44:18according to this formula we can
44:19actually calculate how much IV fluid
44:21should be given in the patient earlier
44:22it was 4 into body weight into total
44:25body surface area Bond but now it has
44:26been modified
44:27okay that now they are saying it is two
44:31into body weight into total body surface
44:32area Bond so now if the question is
44:34coming please mark this answer
44:36next thing over here is uh
44:38how actually we are giving this video
44:40for example the patient is there who is
44:42having 100 kgs of weight
44:44right patient is there came to your unit
44:48and patient weight is 100 kgs right and
44:52you calculated the how much body surface
44:54area has been burned and it came out
44:56that you know 18 percent total body
44:58surface area was burnt that was 18 total
45:01body surface area burnt
45:04right and now they are asking you how
45:06much IV fluid you should be giving so
45:08simple guys just apply this thing in in
45:11this particular formula so 2 into body
45:14weight body weight is 100 kg multiplied
45:16by total body surface area bond that is
45:1818 your answer came out to be
45:22that is your
45:243600 MLP
45:27right so that much amount of load you
45:29should be giving in this patient okay
45:32now 3600 ml how you will give this fluid
45:35to the patients right so look over here
45:40right so you know
45:43the amount of fluid which should be
45:44given in the first 24 hours how you will
45:47be actually managing this so half of the
45:49fluid you should be giving in first
45:50eight hours and the rest of half of the
45:53fluid you should be giving in next 16
45:54hours so I am saying that
45:57off
45:59of the fluid it should be given should
46:02be given
46:03in first eight hours should be given in
46:05first eight hours
46:09first eight hours okay and
46:13next half of the fluid it should be
46:15given in the so second half of the fluid
46:18second half
46:20should be given
46:22in next 16 hours should be given in next
46:2516 hours
46:29okay
46:30fine so you are having 24 hours
46:33so divide this 24 hours day
46:35okay into two parts eight hours and the
46:3816 hours in the eight hours first half
46:41of the fluid you will be giving in the
46:43second uh in the 16 hours second half of
46:46the fluid should be given so 3600 ml
46:48let's say this patient only 100 kgs
46:49patient was there 18 total body surface
46:51area was burned this patient you
46:53calculated that 3600 ml should be
46:56actually given to this patient so 36
46:58divided by 2 it came out to be 1800 ml
47:01so 1800 ml half of the fluid rate so
47:041800 ml should be given
47:06so what I'm saying is that 1800 ml
47:09should be given in
47:12eight hours
47:14and next 1800 ml
47:16should be given in next 16 hours
47:20okay understood so that's how we should
47:21be giving this IV fluid to the patient
47:24in initial 24 hours
47:26right okay fine I think that has been
47:29cleared how to apply this for Parkland
47:31formula usually they are asking you this
47:34simple questions right okay
47:36now which uh we we shall talk about if
47:39the child is coming to you with the same
47:41question okay so this patient this fog
47:44light formula I told you for the adults
47:47okay this was for adults
47:50this was for adults
47:52right if they are saying children
47:56if they are saying children then formula
47:58is having a little modification only
48:00okay that three into body weight in kg
48:07into
48:08percentage of total body surface area
48:10burned total body surface area
48:14burnt okay so this is the formula for
48:17the children
48:19okay so it's the same thing you can
48:20apply over here but main attachment over
48:23here is in the children I told you that
48:25what is the IV fluid you will be using
48:26in the burns patient that was ringer
48:27lactate right in the initial 12 hours
48:30you should not be using the colloid that
48:32is albumin in the you know after the 12
48:34hours you shall be using the Polaroid
48:36also that is you shall be using the
48:38albumin also now if the children is
48:41there if the if the child is presenting
48:43to you for with the burnt right then in
48:46those cases with the ringer lactate you
48:48should actually add the dextrose
48:50containing fluids also for example DNS
48:52can be added so in the children in the
48:55IV fluid if you are giving then with the
48:57ringer lactate you can add the dextrose
48:59containing fluids also that is DNS for
49:02example right so Ringle lactate along
49:05with that you you might add the dextrose
49:06containing Solutions also now over here
49:08why we are giving this
49:11because we want to
49:12uh you know avoid the dehydration part
49:15so for the maintenance therapy for
49:17maintaining fluids
49:18for maintenance we are giving this
49:21okay for maintenance purpose we are
49:23giving this now how to give this
49:26particular thing so you know there is
49:29also a formula very easy one so 100 ml
49:31per kg
49:34for first 10 kgs
49:39for first
49:4110 kgs in 24 hours okay now
49:4650 ml per kg
49:49for
49:54next to 10 kgs
49:56next 10 kgs
49:59in 24 hours and
50:0320 ml per kg
50:06okay for
50:09every
50:11kg after 20 kg
50:14in 24 hours
50:18right what do I mean by that let's say
50:20the patient weight was 25 kgs let's say
50:24the patient weight was 25 kgs so just
50:27divide it like 10 plus 10 plus 5 right
50:31so for the
50:33first 10 kg you will be giving the 100
50:36ml for the next 10 kg you will be giving
50:39the 50 ml so very easy 100
50:43plus 50 plus for the
50:47last part that is 5 I mean 20 ml kg for
50:50every kg after 20 kg so after 20 you
50:54have having the 5 kg so
50:565
50:58multiplied by
50:59so 20.
51:02right so it will become 100 plus 50
51:06plus 100 so it became 250
51:10ml right so that's how we can calculate
51:12how much amount of dextrose can be given
51:15along with that right so I hope you are
51:17clear with this formula fine okay so now
51:20once we are clear that which flow should
51:21be given IV fluid that is the ringer
51:23elected Hartmann solution right along
51:25with that
51:26in the initial 24 hours albumin should
51:28not be used after that it might be used
51:30in the children textures containing
51:31solution might be added with the ringer
51:33lactate once you are clear with this
51:35that then we shall talk about how to
51:38calculate the if you are giving
51:40the colloid if you are giving the four
51:42four point five percent albumin to the
51:44patient after 12 hours of the burns then
51:46how to calculate it so let me talk about
51:49the colloid also
51:51if we are giving the colloids to the
51:53patient
51:55right if you are giving the college to
51:56the patient then how we are giving that
51:58so let me talk about that as well
52:02in case if you are giving the college
52:03Scholars to the patient that is 4.5
52:06percent albumin you are giving I told
52:08you already that in the initial 12 hours
52:10because the leaking process is becoming
52:13very quick so that's why in the initial
52:16dwellers it should not be used I am
52:17saying after 12 hours you are using this
52:19let's say so how to calculate it is
52:21calculated by
52:23it is calculated by a formula
52:28Muir and Barclay movie and
52:32Barclay formula
52:36okay moving and Barclay formula so what
52:40they say is that you know to in total we
52:42are giving the six portions in total we
52:45are giving the
52:47six portions of the albumin
52:49okay first question how many portions
52:51should be given if you are giving the
52:53albumin to the patient then they say
52:55that one portion how to calculate one
52:58portion one portion equals
53:000.5 into body weight in kg
53:05body weight in kg multiplied by
53:09total body surface area that has been
53:12burnt
53:13okay you might have confusion regarding
53:15this TB assay total body surface area I
53:18will tell you shortly how what is total
53:20body surface area how we are calculating
53:21that I will tell you just wait for this
53:23moment but I told you that I am saying
53:26collards we are giving in the not in the
53:29initial dwellers after that we are
53:30giving
53:31so after that how to calculate there is
53:33a Formula that can be calculated by
53:35mover and Barclay formula what is this
53:37formula this formula says that six
53:38portion of the collet should be given
53:40out of those six portion how to
53:42calculate these portions one portion is
53:44having this formula
53:45okay so 0.5 into body weight into total
53:48body surface area one simple formula
53:50just apply the values body K ah
53:53the percent weight will be given total
53:55body surface area will be given and just
53:57you need to apply this formula now
53:59how you will give this particular thing
54:01for example in the Parkland formula also
54:03I told you that in the first eight hours
54:05you will be giving the half of the fluid
54:06in the next 16 hours you will be giving
54:08the rest of the half of the fluid air
54:10also how we are calculating how we are
54:12giving these six portions so we are
54:14giving these six portions in the 36
54:17hours
54:18we are giving these six portions in the
54:2036 hours
54:23okay in the 36 hours we are giving this
54:26okay so just break it in the 12 12 okay
54:30just break it in the 12 hours
54:32plus 12 hours plus 12 hours right it
54:35became 36 hours
54:37now
54:38we are giving
54:40three portions
54:42we are giving three portions
54:46three portions in the 12 hours okay
54:49every four hours we are giving we are
54:52giving this so every four hours
54:55right
54:57every
54:58four hours we are giving one portion and
55:02we are giving it in 12 hours okay so in
55:04first 12 hours we are giving three
55:06portions with the gap of four four hours
55:08right so let's say now we give one
55:12portion after four hours another portion
55:14will be giving another four after four
55:16hours another portion will be given so
55:18in the first 12 hours you'll be giving
55:19the three portions then
55:22followed by
55:23two portions
55:27in the next 12 hours it means with the
55:29gap of obviously six hours right so
55:33every six hours in 12 hours right so in
55:37the first so
55:38in 36 hours we should be giving the six
55:41portions so 12 12 and 12
55:44so in the first 12 hours you have to
55:46give three portions in the next 12 hours
55:48you have to give two portions in the
55:49last 12 hours you have to give
55:52you know one portion that is the rest
55:54one right so three portions two portions
55:58one portion now over here
56:00so we are left with one portion right so
56:03that
56:05one portion which has been left out
56:07that has to be given in
56:12that has to be given in last 12 hours
56:14right
56:15so
56:16remaining portion in
56:19remaining
56:21caution remaining portion
56:23in
56:25last 12 hours
56:28okay so that's how we are giving the
56:30portions
56:31fine there is no confusion I I hope so
56:35again guys
56:36burned patient came to you check for the
56:39airways check for the breathing
56:40component check for the circulation
56:42component in the circulation form
56:43component you have find out that patient
56:45is in shock let's say the patient was
56:47having the more than 10 to 15 total body
56:49surface area burned then in those cases
56:51you should be giving the IV fluids which
56:53IV fluid should I be choosing I should
56:54choose a crystalloid in the crystalloid
56:56what should I be choosing I should be
56:57choosing the ringer lactate it is also
57:00called as the Hartmann solution with the
57:01ringer lactate
57:03how to calculate what what amount of
57:05fluid should I be I be giving so then it
57:08is calculated by the Parkland formula
57:10parcel formula says that first half
57:13first half of the fluid should be given
57:15in the first eight hours rest of the
57:17fluid should be given in the next 16
57:19hours then in in the cases of children
57:23you might add the textures containing
57:26fluids along with the RL for the
57:27maintenance therapy and in cases if you
57:30are if uh in the initial 12 hours you
57:34should not be giving the albumin or the
57:36colloid but in the after the 12 hours
57:39after completion of 12 hours you might
57:40start with the albumin also how to give
57:43the albumin in the 36 hours you should
57:45be giving the sixth portion how to
57:47calculate that one portion that is 0.5
57:49into total body surface area burned into
57:51body weight okay and after calculating
57:54this that is the formula for one portion
57:56right
57:57and the sixth portion you have to give
57:58actually as a colloid so
58:01how to give six portions just divide the
58:0436 hours into three part 12 hours 12
58:06hours and 12 hours in the first 12 hours
58:07give three portions in the next 12 hours
58:09give two portions in the next 12 hours
58:11give rest of the portion that is one
58:13portion fine I hope everything is clear
58:16till now that was a short summary now
58:19moving further from here how to
58:20calculate the total body surface area
58:22right I was emphasizing on total body
58:24surface area so now I am just starting
58:26with the tbsi total surface area how to
58:28calculate it very very important so how
58:31to calculate this total body surface
58:32area
58:34total body surface area percentage
58:36calculation right so how to calculate
58:41this very simple
58:43we are using the
58:46rule of nine actually it is Alexander
58:48Wallace
58:49we are using this rule Alexander Wallace
58:52rule of nine you might forget the
58:54Alexander it is popularly called as well
58:56as rule of 9.
58:58okay
58:59so what it says guys Alexander Wallace
59:01okay according to him what is the values
59:03rule of nine so he says that you know
59:06just very uh very simple formula I'm
59:09just telling you okay that's how I
59:10remember actually just telling you that
59:12trick okay however I will tell you the
59:14bookish thing also so how I remember is
59:17you know just on one side just write
59:20body part
59:21in case if you are making your notes and
59:23on another side just write the
59:25percentage of total body surface area
59:27burnt
59:29okay now look how simple will it be
59:32remember
59:33okay and believe me if the burn question
59:35is coming in your exam okay 70 to 80
59:39chances are there that they that
59:40question will come from the values rule
59:42of nine they will be asking you how to
59:44calculate the total body surface area
59:46right or they might ask you that you
59:49know
59:49what amount of fluid should be given to
59:51this patient obviously to calculate you
59:54need the Parkland formula and parklet
59:55formula says 2 into body weight into
59:57total body surface area one so
1:00:00for that question also you need the
1:00:02total body surface area and total body
1:00:04surface area you will be calculating
1:00:05from this formula that is the valency
1:00:07rule of nine so that is the importance
1:00:09of this formula right so
1:00:12you know on one side just write body
1:00:14part on another side just right total
1:00:15body surface area which has been burnt
1:00:17very simple total body surface area Bond
1:00:20just remember the nine because it is
1:00:21Wireless rule of nine okay that's why he
1:00:23named is validation rule of nine just
1:00:25remember this nine so you don't need to
1:00:26remember anything on the body part start
1:00:28from the hat only right so in the head
1:00:32right head and neck
1:00:34first of all just write head and neck
1:00:38head and neck
1:00:39okay after the head and neck okay just
1:00:43remember we are having the right Upper
1:00:45Limb left Upper Limb to write that right
1:00:50Upper Limb left
1:00:52Upper Limb right right Upper Limb so
1:00:55head and neck right Upper Limb left
1:00:58Upper Limb then coming to the anterior
1:01:00chest and the upper back so
1:01:04anterior
1:01:06test then behind that we are having
1:01:10upper back
1:01:12anterior abdomen and the lower back
1:01:14write that anterior
1:01:18abdomen
1:01:20and the
1:01:21lower back
1:01:23fine then we are left with the legs
1:01:26so right thigh
1:01:29right let's say this is the leg right
1:01:31thigh right leg
1:01:34okay on the another side left thigh left
1:01:37leg so right
1:01:39right thigh
1:01:42right leg
1:01:45left thigh
1:01:48and left leg okay so what portions we
1:01:52have covered we have to cover the whole
1:01:53body so head and neck area
1:01:55then right Upper Limb left Upper Limb
1:01:59anterior chest upper back anterior
1:02:02abdomen lower back
1:02:04okay
1:02:05right thigh right leg left thigh left
1:02:09leg okay
1:02:11we have left with the genitals part and
1:02:13at last
1:02:15let's write the genitals okay how easy
1:02:18will it be now just remember okay on the
1:02:20other side you don't need to remember
1:02:21anything at all it is the wireless rule
1:02:24of nine the rule is only saying nine
1:02:26nine nine so just write 9 over here just
1:02:29write 9. 9 percent
1:02:32nine percent it is also nine percent
1:02:35this is also nine percent everything
1:02:37becomes nine
1:02:40okay that's how I remember
1:02:44okay there's also nine percent there's
1:02:45also nine percent
1:02:46just genitals are one percent which
1:02:49genitals are one percent right so if you
1:02:52remember like this it will become very
1:02:53easily I'm just repeating once again I
1:02:55didn't like how I'm covering the whole
1:02:56body head and neck nine percent
1:02:59right Upper Limb nine percent left Upper
1:03:02Limb nine percent anterior chest nine
1:03:04percent upper back nine percent anterior
1:03:07abdomen nine percent lower back nine
1:03:09percent
1:03:11right thigh nine percent right leg nine
1:03:13percent
1:03:14left thigh nine percent left leg nine
1:03:17percent and left with the genitals that
1:03:19is one percent if you will calculate one
1:03:21two three four five six seven eight nine
1:03:23ten eleven nine into eleven ninety nine
1:03:25plus one
1:03:27hundred so it became total became
1:03:29hundred percent hundred percent of the
1:03:30body you have involved so that is the
1:03:32total
1:03:33okay so that's our whole body has been
1:03:35covered
1:03:36right so it is very simple so that's how
1:03:38you can calculate let's say the question
1:03:40came uh the patient anterior chest right
1:03:43anterior chest and anterior abdomen has
1:03:45been burned
1:03:46so anterior chest contains nine percent
1:03:49anterior abdomen nine percent nine plus
1:03:51nine eighteen eighteen percent is the
1:03:52total body surface area burnt right now
1:03:55accordingly if they're asking you uh
1:03:57what amount of color you should be
1:03:58giving what amount of ring uh IV fluid
1:04:01you should be giving you can calculate
1:04:02easily because you now you know the
1:04:04total body surface area they will be
1:04:05giving the weight of the patient as well
1:04:07and now you can easily calculate
1:04:09okay so that is the importance of
1:04:11calculation for the uh values rule of
1:04:14nine this is the Alexander velas rule of
1:04:15nine okay and if the question is coming
1:04:18in the exam they are expecting you to
1:04:20calculate the total body surface area
1:04:21with the help of this formula only that
1:04:24is the Alexander Wallace rule of nine I
1:04:26hope it became very simple for your
1:04:28convenience part okay just adding the
1:04:30image also
1:04:33over here
1:04:35right
1:04:38okay just added the image as well so
1:04:41here also same thing okay so head and
1:04:44neck ah
1:04:47I don't like it contains nine percent
1:04:48actually 4.5 on this side 4.5 on the
1:04:51back side anterior and back okay oh this
1:04:54is the different formula
1:04:56this is actually the learn London
1:04:58Browder chart Okay so
1:05:04yeah this is that formula
1:05:06so let me just introduce
1:05:08you over here as well
1:05:14okay yeah so this is the formula so here
1:05:17you can see the head and neck area Okay
1:05:19in total it is containing the nine
1:05:21percent arms it is containing the 99
1:05:23percent each right then trunk 36 percent
1:05:26in total right generators one percent
1:05:29and like 18 right but how I remember I
1:05:33remember with this one okay just
1:05:34covering from head to toe okay nine nine
1:05:37nine nine and generators contain one
1:05:39percent right so that is that becomes
1:05:40very easy to calculate okay once you are
1:05:43clear with this uh this is the way
1:05:45that's how we are calculating the how
1:05:48much total body surface area has been
1:05:50burnt okay I hope this became easy but
1:05:52if they are asking you what is the
1:05:55formula by which
1:05:58correct estimation can be actually known
1:06:01then in that cases London router chart
1:06:03can be used right so they are saying
1:06:05that the best method to calculate total
1:06:07body surface area that is the London
1:06:09router chart so here you can see the
1:06:11London router chart so these values are
1:06:13confusing nobody will be asking you this
1:06:14thing but they had asked you once that
1:06:17which is the best method to calculate
1:06:19total body surface area bond that is the
1:06:21London router chart so this chart will
1:06:23be actually you know pasted on in the
1:06:25burns unit and according to according to
1:06:27that they can be estimated but values
1:06:29rule of 9 is giving the broader idea in
1:06:31our picture that has that much amount of
1:06:32total body surface area has been burned
1:06:34and why the residents why the health
1:06:36clinicians are actually calculating the
1:06:38total body surface area because they
1:06:40have to give the fluids IV fluids right
1:06:42so for giving the IV fluid they will be
1:06:44using the power plant formula right and
1:06:46for using the Parkland formula you need
1:06:48the total body surface area burnt that's
1:06:50why the values rule of 9 comes into the
1:06:53picture
1:06:54okay I hope that is clear
1:06:57great
1:06:58now uh just moving on from here so uh
1:07:02let me just document it what I said that
1:07:04learned and Browder chart
1:07:07ER chart okay what it is telling you
1:07:11actually it is just telling you that
1:07:13best method to calculate total body
1:07:15surface area best method
1:07:18to calculate
1:07:22total body surface area total body
1:07:27surface area burnt
1:07:29okay and this is the this is that chart
1:07:33don't end Browder chart
1:07:37okay
1:07:38I hope this is clear fine now just
1:07:42moving on from here and now I am moving
1:07:44on to the severity of burn areas and
1:07:46severity of burn areas can be estimated
1:07:49by the help of zones of the bones right
1:07:52so severity of the burn areas
1:07:56severity of the burn areas
1:08:01right so how we can know the severity of
1:08:04burn areas right it can be estimated
1:08:06estimated by the help of three things uh
1:08:09three areas three zones are there
1:08:10actually so first one is the
1:08:13zone of
1:08:16coagulation or it is also called as the
1:08:18zone of necrosis
1:08:20or it is also called as the zone of
1:08:23necrosis
1:08:26right the second Zone if we talk about
1:08:29in the second Zone we are saying that
1:08:31this is the zone of
1:08:33stasis
1:08:36and the third one is the zone of
1:08:37hyperemia
1:08:39Zone off
1:08:41hyperemia
1:08:45right let me just introduce you the
1:08:47picture so that you can really
1:08:48understand what I am saying okay I will
1:08:51just slide this picture down so that you
1:08:53can understand it yeah just putting it
1:08:55over here okay
1:08:56so here what you can see is that if the
1:08:59bond has been there in the uh in any
1:09:02part of the body right so you know this
1:09:06burn might be having the zones
1:09:08the center zone is called as the zone of
1:09:10coagulation right or it is also called
1:09:12as the zone of cell death right or the
1:09:15zone of necrosis so over here direct
1:09:17tissue injury has been happened and this
1:09:19zone is actually having the irreversible
1:09:22kind of injury okay it is very difficult
1:09:24to actually save that area right so
1:09:27irreversible kind of injury has been
1:09:29happened in that and it usually happens
1:09:31in the center of the bone as you can see
1:09:32in this picture this is the zone of
1:09:34coagulation or the necrosis now
1:09:37periphery to that the orange color which
1:09:39you are seeing that is the zone of
1:09:41stasis right here the cells are viable
1:09:44but vulnerable okay if you are giving
1:09:46the right treatment to the patient
1:09:48it can convert into the
1:09:50hyperemic Zone which is the last Zone
1:09:52which is giving the yellow which is
1:09:54given in the yellow color zone of
1:09:55hyperemia here the tissue recovery are
1:09:58very nice so if the zone of stasis says
1:10:00that if the proper treatment has been
1:10:01given it might it might it might convert
1:10:04into the zone of hyperemia if the
1:10:07treatment has not been given adequately
1:10:09then it might convert into the zone of
1:10:11coagulation so it is kind of a in
1:10:13between right it is kind of a sandwich
1:10:14so
1:10:16in which zone of stages if with proper
1:10:19treatment it might convert it to zone of
1:10:20hyperemia with improper treatment it
1:10:23might go towards the zone of coagulation
1:10:24right so that is the importance of
1:10:26knowing the zones of burns over here
1:10:28that has been asked ah repeatedly so
1:10:32just writing it over here in the zones
1:10:34of coagulation what we are seeing
1:10:36basically the cells has been dyed okay
1:10:39and this is the most severe
1:10:42injury most severe uh burn portion
1:10:48okay and here you can see that the
1:10:51injury which is happening that is
1:10:53irreversible so irreversible injury
1:10:58irreversible
1:11:00in G right in the next one that is the
1:11:02zone of stasis that is peripheral to the
1:11:04zone of coagulation as you can see in
1:11:07this picture this is the orange color
1:11:09orange color line orange color area
1:11:10which is shown by the zone of stasis in
1:11:13this zone of stasis
1:11:14I told you that if the proper treatment
1:11:17has been given I'd convert into the zone
1:11:19of hyperemia if not then might might
1:11:21have converted into the zone of
1:11:22coagulation also so here in the zone of
1:11:25stasis I can say that reversible this is
1:11:28a reversible injury
1:11:29this area might be salvaged and here the
1:11:34patient might have been experienced the
1:11:37variable degree of vasoconstriction okay
1:11:39the patient might have the
1:11:40vasoconstriction
1:11:42in this area and due to that
1:11:45ischemia might be seen
1:11:48right and due to that schema might be
1:11:51seen in this patient now in the zone of
1:11:54hyperemia you will be seeing obviously
1:11:56it is the reversible injury
1:11:58reversible injury has very good chances
1:12:00of survival of this portion of the
1:12:02tissue and in this in this kind of
1:12:05particular zone of hyperemia the
1:12:07vasodilation can be seen and due to the
1:12:09vasodilation the color will be
1:12:10converting into red color so that's why
1:12:13this area is called as the hyper give me
1:12:17a hyperemic zone right so over here that
1:12:20is the hyperemic zone right
1:12:22fine so because the engineer will happen
1:12:25I told you the inflammatory media
1:12:26address will be causing the inflammatory
1:12:27response and all these are the
1:12:28inflammatory mediators in this image
1:12:30they are showing you inflammatory
1:12:32mediators so these are the inflammatory
1:12:33mediators like histamine prostaglandins
1:12:35leukotriines right interleukin-6 and to
1:12:38look in One beta TNA will find all
1:12:40these are the things right so that is
1:12:42the thing I have told you about the
1:12:44systemic inflammatory response also
1:12:45right if the burns are you know uh
1:12:49involving much area of the body okay
1:12:53once we have uh talked about the zones
1:12:55also now I am going into the degrees of
1:12:58burns so for the degrees of burns okay
1:13:00you just need to see this picture
1:13:04okay so just a sec so that we can talk
1:13:07about the degrees of ones yeah
1:13:10fine
1:13:11so here what I can see is
1:13:13that
1:13:16there are several degrees of burns
1:13:19okay so classification by the adapter
1:13:21one so here we are talking about the
1:13:22degrees of burns
1:13:26okay
1:13:29no degrees of burns
1:13:33right
1:13:35so we are having the usually four
1:13:37degrees of burns first degree second
1:13:38degree third degree and the fourth
1:13:40degree in the first degree that is very
1:13:42superficial kind of burn right in the
1:13:44second degree we are talking about the
1:13:47uh partial thickness Burns and the uh
1:13:51partial thickness Burns which means the
1:13:53partial uh partial dermises has been
1:13:56involved or the upper dermis which is
1:13:58the papillary dermis has been involved
1:14:00in the second degree burns uh next
1:14:02category is involving the epidermis and
1:14:05the reticular dermis in the next
1:14:07category that is the third degree they
1:14:09are having the full thickness bones and
1:14:10the four degree having the full
1:14:12thickness bonds right so over here we
1:14:14are seeing that superficial first degree
1:14:16burns
1:14:18okay so here you can see superficial
1:14:21first degree burn that is involving the
1:14:22epidermis right and if you will apply
1:14:25the pressure on that area they are
1:14:27showing the blanching rhythma right they
1:14:30are showing the blanching and they are
1:14:31usually very painful right and they are
1:14:34actually healing without scaring and
1:14:36five to ten days
1:14:38in 5-10 days healing will be there for
1:14:40example sunburn is the best example so
1:14:42in the sunburn what is happening the
1:14:44area is becoming that you know the
1:14:46exposed area is becoming hyperemic red
1:14:48in color but after you know four to five
1:14:51days or after a week or so the you know
1:14:54without scaring or without any kind of
1:14:56marking without any kind of scaring the
1:14:58tissue is becoming better right the
1:15:01tissue has been healed properly in the
1:15:03if you come towards the second degree
1:15:04burn right in the second degree you are
1:15:06talking about the ah two types
1:15:08superficial partial one superficial
1:15:10partial thickness and the D partial
1:15:12thickness in The Superficial partial
1:15:14thickness upper dermis that is the
1:15:15papillary dermis has been involved
1:15:18papillary dermis along with the
1:15:20epidermis right along with the epidermis
1:15:24and in the lower and in the deep partial
1:15:27thickness obviously epidermis has been
1:15:29involved along with that
1:15:31reticular layer of dermis is also
1:15:32involved
1:15:34right reticular layer of the terminal
1:15:35has also been involved then you can see
1:15:37the blister blister is very important
1:15:39they generally ask you blister formation
1:15:41is seen in which degree of burns so that
1:15:43is the partial thickness second degree
1:15:45burn right partial thing is second
1:15:47degree burn and uh or in fact very
1:15:50specific answer will be superficial
1:15:52second degree burns right
1:15:54okay it they are also very painful and
1:15:58they might be healed on their own but
1:16:00without uh scaring
1:16:03but they will be taking much more time
1:16:06obviously they will be taking around two
1:16:08to three weeks or more than that okay
1:16:10now
1:16:12uh second degree burns but the Deep
1:16:15category I mean epidermis is involved
1:16:17first of all first degree burns only the
1:16:19epidermis then second degree burns after
1:16:21the epidermis obviously the epidermis
1:16:23will be involved then they might involve
1:16:25the superficial layer of dermis also
1:16:27that is the epidermis Plus
1:16:29partial layer uh EP determines plus
1:16:31papillary layer in the second degree
1:16:34full thickness burn or the Deep
1:16:36thickness Burns in that case epidermis
1:16:38plus papillary as well as reticular
1:16:40dermis might be involved then comes the
1:16:42third degree in the third degree you can
1:16:45see
1:16:46the full thickness bones okay in the
1:16:48full thickness bones and in the
1:16:51in this one you can see the epidermis is
1:16:53involved old dermis is involved with
1:16:56that subcutaneous tissue is also
1:16:57involved
1:16:59subcutaneous
1:17:00tissue is also involved in this case
1:17:03right so that is very important to know
1:17:05next thing is you can see the appearance
1:17:07that can be white or blackish or brown
1:17:10that is non-blanching uh decrease
1:17:12sensation there is no pain they are
1:17:14painless
1:17:15right they are painless and in the deep
1:17:18partial thickness bonds also they are
1:17:20actually painless but they might show
1:17:22pain
1:17:24in the
1:17:26if you are pricking them then they might
1:17:29be having pain otherwise the nerve
1:17:31endings has been burnt off right and due
1:17:34to the sensory receptors has been
1:17:35destroyed okay that's why they don't
1:17:37feel pain if you will be giving pain
1:17:38stimulus to the third degree burns
1:17:41patient or the fourth degree burns
1:17:42patient they will not be showing any
1:17:44kind of reaction because the burns and
1:17:47for the due to the burns the nerve
1:17:49endings has been burnt off and that's
1:17:51why they don't feel
1:17:52uh any kind of pain over there so they
1:17:54are completely painless so remember that
1:17:56they are asking you in these these kind
1:17:58of things in the mcqs also that if the
1:18:00patient is having the pain in the third
1:18:02degree of four degree burns right so
1:18:04answer is obviously no they are not
1:18:06having the pains so
1:18:09third degree patients uh they are having
1:18:11the contractures they are healing by
1:18:12contractures and uh you know more than
1:18:15eight weeks they will be showing the car
1:18:18formation okay with this car obviously
1:18:20they will be uh going right and here
1:18:23this kind of patient needs the help of
1:18:25the plastic surgeon because they will be
1:18:27releasing the contractures okay fine
1:18:30then you are having the four degree
1:18:31burns over there you know that is very
1:18:34very bad burns the necrosis will be
1:18:36happening in some cases they might need
1:18:37the ampetitions as well right so we need
1:18:40to remove that part of uh that part of
1:18:43the area of the burn which has been
1:18:44completely necrotized or has been you
1:18:47know involved in the gangrene okay so
1:18:49that would be the fourth degree months
1:18:51fine so just documenting that as well so
1:18:55in the fourth degree burn you what you
1:18:56will be seeing fourth degree burn
1:18:58because that is not involved over here
1:19:00four degree burn that's not written over
1:19:02here the four degree burn usually
1:19:05uh they are you know involving
1:19:08everything epidermis older maze
1:19:10subcutaneous tissue some muscles and
1:19:12sometimes bone also so what is involved
1:19:14aperture means plus dermis
1:19:18plus subcutaneous tissue
1:19:21right along with that
1:19:23muscle I'd be involved in some cases
1:19:26bone might be involved as well okay now
1:19:30these are four degree burns so obviously
1:19:31you know what is the prognosis prognosis
1:19:33would be very very bad right so usually
1:19:35uh in this kind of patients if you talk
1:19:39about the four degree you know what will
1:19:42the color usually they are very blackish
1:19:44in color or the pale in color
1:19:47do the patient do these kind of patient
1:19:49will feel pain obviously not they will
1:19:51be having the painless sensation right
1:19:53okay so once you understood this now I
1:19:56am moving on to the next section and
1:19:57that would be the uh you know overall
1:19:59pictures overall picture of the burn
1:20:01actually that how the patient can be
1:20:03managed so once again let's look over
1:20:06this picture so
1:20:07here now what we have talked about the
1:20:09burn patient came to your trauma unit
1:20:11obviously you will be looking for the a
1:20:13b c d component right you will be
1:20:15looking for
1:20:16ABCD component right so
1:20:19a b c d that is the airway breathing
1:20:21circulation and disability component you
1:20:23will be seeing them
1:20:24then
1:20:26uh first thing second thing if the
1:20:28patient is coming okay for example
1:20:31if some patient is coming for example
1:20:34hand burned okay and came to your
1:20:36casualty then wash
1:20:39the you know wound of this patient so
1:20:42what's the burnt area
1:20:46okay and please remember you will be
1:20:48washing this burnt area with the room
1:20:50temperature only okay with the
1:20:54room temperature water only
1:20:57okay room temperature water only okay
1:20:59please remember this then if the patient
1:21:02is having let's say superficial second
1:21:05degree burns right so in those cases
1:21:07obviously you'll be seeing the blister
1:21:09formation so don't actually don't burn
1:21:12the blisters or I will say uh you know
1:21:14don't burst this kind of blisters
1:21:16because they will be causing much more
1:21:18pain right so don't post the blisters in
1:21:21case if it is second degree burn
1:21:23don't burst the blisters
1:21:25right next thing over here is you should
1:21:28be giving what you should be giving the
1:21:29I will switch to the patient right so
1:21:31give the proper IV fluids whichever
1:21:34fluid you will be giving ringer lactate
1:21:37okay
1:21:38then if the patient is having uh the
1:21:42burns okay in some patients they will
1:21:44not be able to eat also right and in
1:21:47some patient their chances of you know
1:21:50distension of the stomach and distension
1:21:52of the abdomen so in those cases you
1:21:55might use the insertion of you might do
1:21:58the insertion of nasogastric tubes or
1:22:00nazogastic tube or also called as the
1:22:02iOS tube right so in those cases you can
1:22:04use that NG tube or else tube because it
1:22:07is having two benefits guys
1:22:09first is that you can cause the
1:22:11decompression
1:22:13of the abdomen you can cause a
1:22:15decompression
1:22:16second benefit is that with the help of
1:22:19the decompression you can get rid of
1:22:22that particular distention part second
1:22:24thing is you might feed the patient also
1:22:26so feeding can be done through the Royal
1:22:27strip only right in case if the internal
1:22:30feeding is not possible you might give
1:22:32the
1:22:33you know just insert the NG tube very
1:22:36very easy to insert it and then you can
1:22:38start the feeding through the angiotube
1:22:41only right
1:22:43what kind of diet if I'll be asking you
1:22:45what kind of diet you would like to give
1:22:46to these patients
1:22:47now you'll be saying the patient was
1:22:49losing the
1:22:50proteins or albumin so high protein diet
1:22:54okay so no need to think much in this
1:22:57case obviously high protein diet the
1:22:58patient would be taking now if the
1:23:00patient is having formation of Aster
1:23:02right I told you what is astral
1:23:04formation so Azure formation is that you
1:23:06know thickish kind of a layer of the
1:23:08skin has been formed in the patient so
1:23:10if the Azure formation is there
1:23:12obviously the plastic surgeon will be
1:23:14doing the asherotomy they will be
1:23:16actually cutting that actually right
1:23:19okay fine and removing the gangriness
1:23:21part of the skin
1:23:23okay fine so if the actual formation is
1:23:25there you need to do the asterotomy now
1:23:28if you will be going uh let's say if you
1:23:30are having a posting in the surgery
1:23:32department or if you are if you are an
1:23:34intern in the surgery Department usually
1:23:35uh if you're if you'll be doing the
1:23:37internship in the surgery Department
1:23:38then what your job will be in the early
1:23:41morning you need to take the Sam you
1:23:43need to take the vitals of the patient
1:23:44if you are posted in the surgical boards
1:23:47then you need to take the blood samples
1:23:49of the patient and after that you will
1:23:51be helping your residents in the
1:23:53dressing of the patients now
1:23:56if you are doing the dressing of the
1:23:57patient obviously the burn patient also
1:23:59will be present some of some here and
1:24:01there the burn patient might also be
1:24:03there in your surgery department so in
1:24:05the surgical Ward so what could be uh
1:24:08what could have been seen you will be
1:24:09doing the dressing
1:24:10so in the dressing part what kind of
1:24:13dressing uh can be done in uh you know
1:24:16several degrees of burns let's talk
1:24:17about that also so guys let's say here
1:24:20are the stages
1:24:21okay so stages of the bones and here you
1:24:26can write the management part
1:24:29okay so for an example
1:24:32let's say that
1:24:34there is first degree burn
1:24:36okay and the first degree burn you don't
1:24:38need the dressing just expose the wound
1:24:41clean it off and that's it so in the
1:24:43first degree burn you just need to
1:24:44expose the wound
1:24:47okay just need to expose the wound
1:24:51just clean it or clean it out
1:24:52superficially and all okay you don't
1:24:54need the dressing actually if the
1:24:57patient is having obviously second
1:24:58degree burn
1:25:01here you need the dressing okay either
1:25:03second degree burn if it is superficial
1:25:04only it means epidermis and the
1:25:07papillary layer of the dermis has been
1:25:08involved in those cases we are using the
1:25:10Vaseline or the paraffin Gauss so if it
1:25:13is superficial if it is superficial then
1:25:15we are using the paraffin goes
1:25:18dressing
1:25:20paraffin
1:25:22gauze or Vaseline gauze dressing
1:25:26right Vaseline goes
1:25:28dressing
1:25:30okay now the benefit of using this
1:25:32paraffin Gauss or Vaseline Gauss is it
1:25:34is actually stick in nature right
1:25:36actually it is having a you know you
1:25:38know the Vaseline right what is the
1:25:40nature of Vaseline okay so you will be
1:25:42having these kind of Gauss pieces when
1:25:44you'll be doing the dressing of these
1:25:46kind of gauge pieces and you will be
1:25:47doing the dressing over it
1:25:49after that let's say next day when you
1:25:52will be opening up the dressing okay
1:25:53these Gorge pieces will not be sticking
1:25:55to the wound actually okay so you can
1:25:57easily remove them otherwise what could
1:26:00have been happen they might be sticking
1:26:01to the wound and it will be very
1:26:03difficult to remove those kind of uh you
1:26:06know Gorge pieces so that's why special
1:26:08kind of Vaseline or the paraffin Gorges
1:26:10are paraffin gauze is actually used for
1:26:13the dressing of The Superficial second
1:26:15degree burns okay if uh some of you uh
1:26:19might have been posting in the surgery
1:26:20Department you might have seen it as
1:26:21well now
1:26:24next thing second degree
1:26:27deeper ones second degree deep bones
1:26:31okay which layer will be involved over
1:26:33here
1:26:34which layer will be involved over here
1:26:36that will be the epidermis plus
1:26:38superficial Hermes that is your
1:26:41papillary and reticulate Hermes as well
1:26:43so over here what kind of dressing you
1:26:46will be using the collagen dressing you
1:26:47will be using
1:26:49collagen dressing okay if you're using
1:26:52the collagen dressing or you might use
1:26:53the hydrocaloid dressing as well
1:26:57okay just for the examination purpose
1:26:59I'm telling this hydrocollar dressing or
1:27:01the collagen dressing in case if they're
1:27:02asking you what kind of dressing can be
1:27:04used in the Deep second degree burns
1:27:07right then
1:27:10this thing is clear Okay then if they're
1:27:12asking you uh the Azure formation I told
1:27:14you the heterotomy should have been done
1:27:16over there right and please to remember
1:27:18that uh your job will not be finished by
1:27:21doing the dressing part you actually
1:27:23need
1:27:24uh you actually need to change the
1:27:26dressings in a regular period of time
1:27:28because uh the infection might develop
1:27:31in these kind of dressings right so
1:27:33always there is a risk of secondary
1:27:35bacterial infection and usually the most
1:27:37commonly we are seeing the pseudomonas
1:27:38is actually growing in these kind of
1:27:40dressing pseudomonas bacteria and
1:27:42usually how to identify the pseudomonas
1:27:44uh bacteria in the dressing first of all
1:27:46a very unpleasant smell will be coming
1:27:48from the wounds secondly they mind the
1:27:51pseudomonas might stain the dressing
1:27:53with the green color so if you are
1:27:55seeing the greenish kind of pattern in
1:27:57the dressing color and special you know
1:27:59unpleasant kind of smell is coming from
1:28:01that dressing then obviously you might
1:28:04think of the pseudomonage dressing so it
1:28:06is very common in the burns patient so
1:28:08that's why proper hygiene proper
1:28:10dressing care should be done in the
1:28:12burns patient right okay so once we are
1:28:15clear with that let's move on to the
1:28:17next Point uh you know which kind of
1:28:19special you know which kind of
1:28:20antibiotic which kind of drugs we can
1:28:23give to these kind of patients while you
1:28:25know treating these bonds patient
1:28:27obviously we have talked about the IV
1:28:29fluid part that will take care of the uh
1:28:31you know shock and all but here uh let's
1:28:34say The Superficial burn was there okay
1:28:36what kind of cream you can apply uh over
1:28:39here or some kind of antibiotics you can
1:28:41give over here so
1:28:43in this case we might use some of the
1:28:45drugs okay
1:28:47so some drugs or
1:28:52some topical applications I'm just
1:28:54telling you first of all we are having
1:28:57ah silver sulfadiazine which is used
1:28:59very commonly also
1:29:01silver sulfur diazine
1:29:04okay and that is one percent
1:29:07it is used very commonly okay you might
1:29:09have seen as well the most commonly used
1:29:13okay and it it is also causing the
1:29:16discoloration of the dressing part okay
1:29:17it is also causing the discoloration of
1:29:19that particular area okay that is kind
1:29:21of you can say side effect or something
1:29:22else but that is kind of a negative
1:29:25point over here it is used very commonly
1:29:26and it is good against the bacteria also
1:29:28it is good against the pseudomonas
1:29:30bacteria it is uh it is working very
1:29:32good against the gram negative kind of
1:29:33bacteria also so these this is giving
1:29:36the bacterial protection but actually uh
1:29:39you know whenever you are actually
1:29:41applying it it is actually staining the
1:29:44the black color onto that particular
1:29:47tissue okay so that is kind of a
1:29:49negative point over there now over here
1:29:51so I'm just writing over here that uh
1:29:53causing the discoloration of that part
1:29:57causing discoloration of tissue
1:30:00right causing discoloration of the
1:30:01tissue second point over here is that
1:30:04here if the aster formation is there
1:30:07right black black assure formation is
1:30:08there it cannot penetrate that Azure
1:30:11formation so can't penetrate as sure
1:30:14okay that is also the negative point
1:30:19okay but working good against
1:30:22the bacteria working good against the
1:30:24bacteria working good against the
1:30:26pseudomonas bacteria
1:30:28and even the Dominos
1:30:31and even the gram-negative bacteria too
1:30:34gram-negative bacteria 2 right
1:30:38okay second
1:30:40formulation we are having that is the
1:30:42silver nitrate cream
1:30:44you might have heard it very commonly
1:30:46also silver nitrate cream
1:30:48okay in the silver nitrate game what we
1:30:50are using actually you know it is also
1:30:52having a good action against the uh
1:30:54basically pseudomonas but here the
1:30:58gram-negative bacteria if you talk about
1:30:59it is having a weaker activity against
1:31:01it right so
1:31:04over here if you talk about
1:31:06the inverse Alpha Dyson is used
1:35:36foreign
1:35:44okay
1:35:54fine
1:35:58okay great so
1:36:01I hope there is no issue with the audio
1:36:02and video again guys
1:36:07okay fine
1:36:11right okay so I was talking about some
1:36:14drugs which we can use uh you know
1:36:15topically as far as the buns are
1:36:18concerned so I I had talked about the
1:36:20syllabus alpha diazine one percent we
1:36:22can use which is used very commonly then
1:36:23I told you that silver nitrate but the
1:36:25weaker action against the pseudomonas
1:36:27and uh you know that is the basic thing
1:36:30uh weaker action against the
1:36:32gram-negative bacteria mainly and that
1:36:34is the negative Point against the silver
1:36:37nitrate then we are having one more
1:36:39good application
1:36:42one more drug that is the
1:36:44so let me just complete it good action
1:36:47against pseudomonas
1:36:49good action against
1:36:52pseudomonas
1:36:56right
1:36:58okay
1:36:59now
1:37:01third point over here
1:37:03third drug which uh which we try to talk
1:37:05about that is the mafinite acetate
1:37:10methanide
1:37:13acetate right aphenid acetate
1:37:16five percent okay
1:37:19it is having the capability to penetrate
1:37:22the S Char formation
1:37:25right
1:37:26look at the power of this drug look at
1:37:28the power of this drug it can actually
1:37:30penetrate it is one of the carbon carbon
1:37:32in an address inhibitor right so main
1:37:34side effect is that it can cause the
1:37:36metabolic acidosis in the burns patient
1:37:38we know that metabolic acidosis might
1:37:39happen that's why we were using which
1:37:41fluid we were using the ringer lactate
1:37:43solution over here the main side effect
1:37:45is the Metabo it can cause metabolic
1:37:46acidosis because Carbonic and nitrogen
1:37:48Inhibitors cause metabolic acidosis so
1:37:50it might also cause that so might cause
1:37:53might
1:37:56cause metabolic acidosis metabolic
1:37:59acidosis because it is carbonic and
1:38:01nitrous inhibitor but it can penetrate
1:38:03the texture formation that strong
1:38:06uh action it is having so next thing is
1:38:10that after that we can use one more that
1:38:13is the best agent but not very commonly
1:38:16used because it is not very commonly
1:38:19available also that is a cerium nitrate
1:38:22now serum nitrate it is actually the
1:38:25best agent among all all of these agents
1:38:27and
1:38:28second thing is that it is having a good
1:38:32immunomodulatory actions
1:38:35good immunomodulatory
1:38:38effects right
1:38:40it is causing the good wound care in the
1:38:42Lesser type
1:38:44okay
1:38:45fine
1:38:46now if we move further okay we shall
1:38:48talk about what are the causes of the
1:38:50that what are the causes of the death
1:38:52following the burns right so the
1:38:55question are usually they are asking you
1:38:56the questions like you know what is the
1:38:59cause of death what is the late cause of
1:39:01death in the burns patient what is the
1:39:03early cause of death in the burns
1:39:05patient like that so causes of death
1:39:07following Burns patient
1:39:10right
1:39:12so
1:39:13causes of death
1:39:18following Burns patient
1:39:20following bonds
1:39:23right so over here we shall talk about
1:39:28uh for example
1:39:30let's say the immediate cause right
1:39:35immediate cause of death following the
1:39:37trauma sorry following the burns then
1:39:40the early
1:39:42early course
1:39:44late cause early cause I mean one two
1:39:47three days
1:39:48and late cause I mean more than three
1:39:51days
1:39:53okay and that is the thing now if they
1:39:57are asking you the immediate cause of
1:39:59death then probably in many cases it is
1:40:01the aspects here the patient is not able
1:40:03to breathe properly and as fixture might
1:40:05have been happened that could be the
1:40:06immediate cause due to the Airways Burns
1:40:08right early phase is that due to the
1:40:11loss of the fluid volume so hypovolemic
1:40:14shock hypovolemic shock is the early
1:40:17cause
1:40:18of death in the burns patient
1:40:20hypovolemic shock
1:40:22right next one is the septic shock in
1:40:25late phase okay that has been asked n
1:40:27number of times okay so it has been
1:40:30asked a number of times the late cause
1:40:32of death in the burns patient that is
1:40:34the sepsis right
1:40:36okay that is the septic shock
1:40:39okay
1:40:40next point over here is overall cause of
1:40:42death if they're asking you
1:40:46overall cause of death
1:40:48overall
1:40:49cause of death
1:40:51in the bones patient then also your
1:40:55answer will remain same that would be
1:40:57the septic shock that would be the
1:40:59septic dog
1:41:03got it so that is about this thing and
1:41:06most common organism uh which is causing
1:41:09the infection in the burns patient that
1:41:11is the pseudomonas and that is giving
1:41:13the unpleasant sensation and next thing
1:41:18is it is staining green color to the
1:41:21dressing dressings right
1:41:24okay now if the patient is having uh
1:41:27some you know in some special conditions
1:41:29the patient might came up to your drama
1:41:32unit or the casualty having the acid
1:41:34burn or The Alkali Bond okay so main
1:41:37point which you need to remember in
1:41:38these kind of burns is we are never
1:41:41trying to neutralize these kind of ones
1:41:43for example if acidic burn is coming we
1:41:45should not neutralize it with The Alkali
1:41:47or if the Alkali bond is coming we
1:41:49should not neutralize it with the help
1:41:51of acid we should not do that so in case
1:41:54if the acid or Alkali bonds are coming
1:41:57in the burns unit acid or Alkali bonds
1:42:00let's say
1:42:02okay these are the chemical burns so in
1:42:05these kind of cases we should actually
1:42:07remember that these should not be
1:42:09neutralized simply we should be washing
1:42:12these with water
1:42:14right wash with water
1:42:18okay never neutralize
1:42:24right never neutralize and if there is
1:42:26some powder and all okay just brush it
1:42:28off and that's it right in the
1:42:32Burns if you are talking about next
1:42:34category that is the electrical bones
1:42:37right that is the
1:42:39electrical bones
1:42:42now in the electrical bonds we are
1:42:44having two categories either there might
1:42:46be the alternating current bonds
1:42:51either there might be the DC Burns that
1:42:54is the direct current alternating
1:42:56current or the direct current usually in
1:42:58our household Supply there is the
1:43:00alternating current right 220 volts so
1:43:03with the alternating current the patient
1:43:05is having the Titanic for example if a
1:43:10you know let's say you were having a
1:43:12shock right not a shock I mean the
1:43:14electric shock okay if you are having
1:43:16the electric shock okay I'm sure you
1:43:18might have experienced it I mean most of
1:43:21you so you are having that
1:43:23you know that sensation so that is the
1:43:26Titanic sensation so Titanic means
1:43:28repetitive contractions of the muscles
1:43:30will be happening okay if the AC current
1:43:32will be there so AC bones will be
1:43:34actually causing the tetany in the
1:43:37patients so chitney for that much amount
1:43:40of time when there was a contact with
1:43:42the electricity so it is causing the
1:43:44chitney now titney means the repetitive
1:43:46contractions of the muscle will be seen
1:43:49repetitive contraction
1:43:52iterative contraction of the muscles
1:43:54will be seen
1:44:02right it will be causing the Titanic
1:44:04actually and due to that it will be
1:44:06causing the muscle injury okay due to
1:44:09that because repetitive contraction of
1:44:11the muscles are happening so due to that
1:44:12muscle injury will be there and due to
1:44:14that muscle injury this is called as the
1:44:16Rhabdomyolysis okay this is called as
1:44:19the Rhabdomyolysis or I would say it
1:44:21will be causing the you know the muscles
1:44:23are containing the myoglobin and that
1:44:26myoglobin will be coming into the blood
1:44:28and then through the blood it will be
1:44:30coming
1:44:30into the urine so myoglobin can be
1:44:33present in the urine so myoglobinuria
1:44:36right so due to that
1:44:38you might be seeing the myoglobinuria
1:44:42okay so the urine color might be
1:44:46urine color might be changed and urine
1:44:49might turn
1:44:52right
1:44:54tea color
1:44:56or the radiation color or the blackish
1:44:57in color okay radish or brownish color
1:45:00discoloration can be there in the urine
1:45:01right in these kind of patients right
1:45:04you need to remember you have to give
1:45:06more and more IV fluids
1:45:08right Parkland formula was 2 into body
1:45:10weight into total body surface area
1:45:13burnt right but if the patient is coming
1:45:15up with the electrical Burns injury then
1:45:18you have to use this formula 4 into
1:45:21total body surface area into
1:45:23percentage of total body surface area
1:45:25burned so if this kind of patient is
1:45:28coming which formula you will be using
1:45:29for the fluid therapy 4 into total body
1:45:32surface area
1:45:34which is burnt into body weight in kg so
1:45:38please use this formula and look at the
1:45:40urine output also in these cases right
1:45:42if the urine discoloration you are
1:45:45seeing in the police bag let's say right
1:45:47then in those cases you have to give
1:45:49more and more amount of fluids and give
1:45:51the fluids until this color is not
1:45:55changes until this discoloration is
1:45:57actually
1:45:58ah you know converting to the normal
1:45:59color or colorless right so till that
1:46:02point of time you should give the roots
1:46:03to the patient okay so that is the thing
1:46:06so that's why
1:46:07monitor the
1:46:10urine output in these cases
1:46:12monitor the urine output
1:46:15in these cases
1:46:17okay that is very important fine once uh
1:46:21we have understood this thing then we
1:46:22shall move on to the next point after
1:46:24the electrical Burns okay so what I told
1:46:27you in the AC bonds it can cause the
1:46:29tightening of the patients right kidney
1:46:31and titanium is a repetitive
1:46:32contractions of the muscles due to that
1:46:34myoglobin might appear in the blood in
1:46:36through the blood it might appear in the
1:46:37urine so myoglobin urea might be seen in
1:46:40the patients and because myoglobin is
1:46:43going to the kidney right myoglobin is
1:46:45going through the kidney and coming into
1:46:46the urine kidney injury might be seen as
1:46:48well so acute kidney injury can be seen
1:46:50because the kidneys are in the stress so
1:46:52acute kidney injury can also be seen Aki
1:46:55can also be seen in this patient acute
1:46:57kidney injury can also be seen as far as
1:46:59DC bonds are concerned okay in the DC
1:47:02Burns we might talk about the
1:47:04art block
1:47:06we might talk about the art block so
1:47:08heart block might be
1:47:10seen in the DC Burns patients okay so
1:47:14once we are done with the electrical
1:47:15Burns now I'm moving on to the lightning
1:47:18bones right so third one I'm just moving
1:47:22on to the lightning bones
1:47:25so lightning bonds very easy to
1:47:27understand here also we are having two
1:47:29types either the direct bone might have
1:47:32been happened or either the indirect
1:47:34Burns might have been happened
1:47:36either the direct bones either the
1:47:38indirect bones now in the direct bones
1:47:43in the direct bones
1:47:45what can be seen
1:47:47so if the bones are happening in the
1:47:49direct bones actually the you know in
1:47:51most of the cases immediate death can be
1:47:53there immediate expiry can be zero the
1:47:55patient because if the directly the
1:47:56lightning is falling on to some person
1:47:58okay so that will cause the arrhythmia
1:48:01in the person and you know the patient
1:48:03might have been died at the spot
1:48:05in these cases what is happening the
1:48:08lightning is actually striking the
1:48:09patient directly okay and due to that
1:48:11due to very high grade of electrical
1:48:13injury the patient might be experiencing
1:48:15the arrhythmias and patient may die at
1:48:17the same time right so what is happening
1:48:19over here very high grade of
1:48:24electrical injury
1:48:26very high grade of electrical injury
1:48:28might be experienced by the patient due
1:48:30to that the patient might feel the
1:48:31arrhythmias might have arrhythmias and
1:48:34the patient might
1:48:37die right if you talk about the indirect
1:48:40one the lightening this time in the
1:48:43direct one lightning is falling onto the
1:48:45person directly in the indirect wind
1:48:47lightning is actually falling onto some
1:48:49object into some metallic object and due
1:48:52to that the that particular person is
1:48:55getting the shock from that or getting
1:48:56the burn from that right so the
1:48:59lightning at this point of time
1:49:01lightning is falling onto some metallic
1:49:03object and
1:49:04through that metallic object the person
1:49:07is getting the burn that is that is
1:49:08considered under the category of
1:49:10indirect bonds so in the indirect bonds
1:49:12a person will be getting the burn
1:49:17through some
1:49:18metallic object through some metallic
1:49:20object
1:49:23matric
1:49:25object right which comes under the
1:49:28influence of lightning which comes under
1:49:31the influence of lightning
1:49:35under the
1:49:38influence
1:49:42of lightning fine
1:49:46okay understood so till now we have
1:49:49understood what is happening now direct
1:49:50injury indirect injury with the
1:49:53lightning bones right in the indirect
1:49:55bones we can see a very popular special
1:49:58kind of pattern and mcqs are actually
1:50:01you know they are asking the mcqs from
1:50:03this point that is the which kind of
1:50:05pattern is seen in the indirect burns
1:50:07from the electricity from the lightning
1:50:09bones that is the filigree patterns so
1:50:12in the indirect bonds we are seeing a
1:50:14very special kind of pattern
1:50:15that is the filigree burn
1:50:21will agree
1:50:22bonds right how they are seeing actually
1:50:25filigree bonds so let me show you as
1:50:27well
1:50:28so
1:50:29this is the image of the filigree buns
1:50:31let me take it to that side
1:50:36right
1:50:38okay so these are the filigree ones okay
1:50:40so here what you can see is that the
1:50:44patient is having the pattern right
1:50:46lightening pattern you can see the
1:50:48lightening pattern over here
1:50:50so that is seen in the indirect bonds
1:50:53right obviously the direct burn from the
1:50:56lightning entry you will not be seeing
1:50:58actually because the patient will
1:50:59already be dead due to the arrangement
1:51:01arrhythmia but over here the filigree
1:51:04Burns can be seen in the indirect injury
1:51:06from the lightning okay understood that
1:51:08is important McQ they might give you
1:51:11this image and they might ask you which
1:51:12what kind of pattern and in what kind of
1:51:14injuries you can see this okay once
1:51:16you're clear with this then we might
1:51:18talk about we might come to the
1:51:19frostbite okay we have talked about the
1:51:21Burns in the burns once again what we
1:51:23have talked about till now we had to
1:51:25talk about the uh you know
1:51:27which patient should be transported to
1:51:30the specialized bond center
1:51:32we had talked about that criteria right
1:51:35then we had to talk about the overall
1:51:37management deck we have to evaluate the
1:51:39Airways breathing circulation and
1:51:41disability disability would be the same
1:51:42you would be scoring you'd be
1:51:44calculating the GCS score and all as you
1:51:46as I have told you in the drama section
1:51:48yesterday
1:51:49then we will be talking about which uh
1:51:52what kind of patient will be needing
1:51:53what kind of fluid so I mean what IV
1:51:56food should be using in this patient
1:51:57that is the ringer lactate solution
1:52:00now if the patient is children then we
1:52:03might use the dextrose containing
1:52:04solution we might add up directions
1:52:06containing Solutions we uh I have told
1:52:09you that how to calculate uh which
1:52:11formula is there how to calculate the IB
1:52:12fluid that is the Parkland formula I
1:52:15have told you that
1:52:18uh what kind of patients after that what
1:52:21is the movie and Barclay formula which
1:52:23is used for the colloid uh calculation
1:52:25part right then we had to talk about the
1:52:28different kind of dressings right we
1:52:30have to talk about the zones of burns
1:52:33actually which was zone of stasis John
1:52:35of coagulation John of hyperemia then
1:52:37we're going to talk about the degrees of
1:52:38the Burn Right stage one two three four
1:52:41and then we'll talk about the dressing
1:52:43materials then we're going to talk about
1:52:44the special agents like silver sulfur
1:52:46diogen silver nitrate cerium nitrate
1:52:48methane acetate then we're going to talk
1:52:50about electrical injuries and the
1:52:52lightning injuries right and the acid or
1:52:55Alkali bones and now uh we will be
1:52:58talking about the frostbite and that's
1:53:00it about the burns actually now we are
1:53:02talking about the frostbite so in the
1:53:04frostbite if you will see
1:53:06so let's uh you know start with the
1:53:09frostbite over here
1:53:13okay so frostbite means basically the
1:53:15ice crystals are forming inside the
1:53:17tissue of the patient right so ice
1:53:19crystals are forming inside the tissue
1:53:22right so ice
1:53:24crystals are
1:53:27formed in tissue
1:53:30and they are causing the membrane injury
1:53:35in the patient
1:53:38right so ice crystals are forming in the
1:53:40tissue right because why the frostbite
1:53:42is happening in a very cold climate
1:53:44right in those areas where the climate
1:53:48is very very cold right let's say minus
1:53:5010 degree minus 20 degree minus 30
1:53:51degree okay these kind of climate so if
1:53:53the person will be if the person tissues
1:53:55body tissue will be exposed to that
1:53:57lethal environment for a very long
1:53:59period of time and it might cause a
1:54:01frostbite of that particular part of the
1:54:02tissue right how the frostbite is
1:54:04actually looking like so this is a
1:54:05picture of showing the first bite
1:54:09okay so here we can see how the cross
1:54:12pad looks okay this is a picture as you
1:54:15can see over here blister formation can
1:54:17be seen right these are the actually
1:54:18vesicles these these These are the
1:54:20vesicles actually which can be seen in
1:54:22the patient okay these are the vesicles
1:54:24which can be seen in the patient and
1:54:26then we shall talk about the grading of
1:54:27the frostbite as well right the grading
1:54:29of the frostbite as well and here
1:54:32we shall discuss about the grading also
1:54:34so this is the grading of frostbite so
1:54:36here also we shall talk about the stage
1:54:38one two three four
1:54:41right so over here the first stage is
1:54:44called as the draw snap
1:54:46then we are having a second stage third
1:54:48stage and the fourth stage in the first
1:54:49stage only the partial skin freezing is
1:54:51there as you can see in this image right
1:54:54in the second stage full thickness skin
1:54:56freezing can be can be seen so thickness
1:54:58will be increasing now and over here you
1:55:00can see the numbness might be there and
1:55:03you can see the edema might be
1:55:06presenting four four to six hours right
1:55:08and the blisters can be seen within 6 to
1:55:1024 hours basically in the stage one of
1:55:13the frostbite that is called as the
1:55:14frost nip you will be seeing the
1:55:15hyperemia only right second thing in the
1:55:19second stage you will be seeing the
1:55:20vesicles are developing on also right
1:55:22vesicles are developing some of the skin
1:55:24loss can be there from there in the
1:55:26third stage you will be seeing
1:55:28that you know the tissue loss actually
1:55:32started in the third stage right tissue
1:55:34loss and the hemorrhagic vesicles can be
1:55:36there we'll Zoom this image you can see
1:55:38the vesicles and inside that they
1:55:40recommended the blood as well Hemorrhage
1:55:41vesicles might be there so you can see
1:55:43the hemorrhagic blisters can be there
1:55:45that is a key word over here over here
1:55:47the normal blister normal vesicles can
1:55:49be there here the hemogic blisters can
1:55:51be there in the fourth stage you can see
1:55:52the black Aster formation as you can see
1:55:54over here these kind of patients might
1:55:56need the amputation as well because
1:55:58gangrene might have been developed and
1:56:01we need to amputate that particular
1:56:02affected area of that particular flow
1:56:05spider
1:56:06okay then we shall talk about the trench
1:56:08foot what is trench food
1:56:11usually if they are asking you trench
1:56:12food they are giving the image
1:56:14okay this is a this is more the image
1:56:16based question they will be giving you
1:56:17the image and that's how the transport
1:56:19looks not very uh good to see actually
1:56:24okay might be disturbing for some so
1:56:27this is the image of the trench foot so
1:56:29here what you can see is if the patient
1:56:31foot or if the patient body part will be
1:56:34actually coming in contact for the water
1:56:36coming in contact with the water for a
1:56:37very long period of time right in those
1:56:40cases you might see that there can there
1:56:42could be the occlusion over there in the
1:56:44micro circulation micro circulation you
1:56:47can see that
1:56:48uh you can see the occlusion over there
1:56:51and due to that this kind of pattern can
1:56:52be seen very not very good to see over
1:56:55here so that is the trench food so what
1:56:57is happening over here prolonged
1:56:59exposure to the cold and uh basically in
1:57:03the water if the tissue is coming in
1:57:06contact with the water for a very long
1:57:07period of time that too cold water right
1:57:10and the tissue is becoming damaged over
1:57:13there tissue is becoming wet and this
1:57:14kind of appearance will be seen so just
1:57:16documenting it what I said that
1:57:18prolonged exposure of
1:57:22tissue with the cold prolonged exposure
1:57:25of
1:57:26tissue
1:57:28with
1:57:29cold water
1:57:31okay and due to that what is happening
1:57:33tissue is becoming wet
1:57:37tissue is becoming wet right so that is
1:57:40the trench foot
1:57:42at last how will you manage these kind
1:57:43of patients so management will be very
1:57:45simple how to manage these patients so
1:57:48Management in the management portion
1:57:49what we will be doing is that first of
1:57:52all you know don't do the rewarming
1:57:54immediately I mean uh you know if the
1:57:58frostbite patient is coming or if the
1:57:59transit patient is coming it's not like
1:58:01you are giving you are pouring the warm
1:58:03water onto it very warm water onto the
1:58:05particular affected tissue okay because
1:58:08if you will be doing that reperfusion
1:58:10injury might have been happened so we
1:58:12need to avoid the reperfusion injury we
1:58:14need to avoid the reperfusion injury
1:58:16what we will do to avoid the reperfusion
1:58:19injury
1:58:20we will actually
1:58:22gradually revolving the particular
1:58:25tissue so gradual revolving is needed
1:58:29gradual revolving
1:58:31is needed okay so if you're pouring the
1:58:34water it should be around
1:58:3640 degree
1:58:37right now if you talk about other kind
1:58:40of complication what could have been
1:58:42happened so hyperkalemia and the
1:58:43acidosis can be seen in such patients so
1:58:46what you can see over here is that
1:58:48potassium levels might have been
1:58:50there
1:58:51high level of potassium can be seen and
1:58:53with that acidosis can be seen so you
1:58:55need to
1:58:56do the correction for these kind of
1:58:57things so hyperkalemia and the acidosis
1:58:59correction
1:59:01must have been done right hyperkalemia
1:59:03collection can be done with the help of
1:59:05injection calcium gluconate or the
1:59:07potassium binders right
1:59:10now with that how to actually uh you
1:59:14know how to record the temperature in
1:59:15these kind of pieces because the patient
1:59:17temperature will be very very uh
1:59:19on the lower side so it will be colder
1:59:22actually so better to take the
1:59:24temperature from the rectal area
1:59:27okay uh not through the auxiliary side
1:59:30or something else better to because
1:59:32exact reading will be coming from the
1:59:34character uh Factor route so from the
1:59:37rectal root we can take the temperature
1:59:38of the patient followed by the isovagal
1:59:40root so
1:59:42from where to take the temperature it
1:59:44will be taken from the rectal root this
1:59:46has also been asked
1:59:47Vector root is preferred
1:59:50and then the esophageal root
1:59:53then the esophageal root right so this
1:59:56has been asked previously
1:59:58right so this was about uh the
2:00:02management of the frostbite and the
2:00:04trenchwood right
2:00:06so we have talked about the burns
2:00:08actually okay and at last we can
2:00:10actually solve one McQ over here that
2:00:12for an example
2:00:14okay the patient
2:00:17had the burn
2:00:20okay involving
2:00:25a patient at the burn involving the
2:00:28both upper limbs
2:00:32right both upper Limbs and lower limbs
2:00:35both upper Limbs and
2:00:38lower limbs
2:00:40okay the patient
2:00:43body weight is
2:00:46100 kgs let's say
2:00:49okay so what amount of fluid should be
2:00:52given to these patients what amount of
2:00:55fluid should be given to these patients
2:00:59what amount of fluid
2:01:02should be given to these patients right
2:01:05okay so can somebody answer what amount
2:01:07of fluid can be given to these patients
2:01:09okay first of all obviously I'm just
2:01:11giving the hint first of all in this
2:01:13case you need to calculate what is the
2:01:15total body surface area
2:01:18okay
2:01:20in percentage right body weight is also
2:01:22given I'm just waiting if somebody can
2:01:24answer that uh if somebody can answer
2:01:28what should be the
2:01:29answer over here in this case
2:01:34okay
2:01:37if somebody can answer this question
2:01:39both upper limbs has been involved has
2:01:42been burned giving you the hint
2:01:45that Wallace rule of 9 is used to
2:01:47calculate the total body surface area
2:01:49right so what should be the answer over
2:01:51here
2:02:11so upper dims
2:02:13and the lower limbs
2:02:16both has been involved so over here both
2:02:18upper limbs means 9 plus 9 that would be
2:02:2118 okay and lower volumes 9 plus 9 that
2:02:24will be 18 so total body surface area
2:02:26came out to be 36 percent so 36 percent
2:02:29total body surface area
2:02:31now you need to use the Parkland formula
2:02:33you need to use the Parkland formula
2:02:38okay meanwhile question is open to all
2:02:41you can answer in the comment in the
2:02:43chat box so in the Parkland formula I
2:02:46told you it was 2 into
2:02:48body weight
2:02:51in kgs
2:02:53into
2:02:55total body surface area that has been
2:02:57burnt
2:02:58right so just apply this Formula 2 into
2:03:01body weight is given that is 100 kgs
2:03:03right and total body surface area which
2:03:07is 36 percent
2:03:09okay
2:03:10so
2:03:13200 into 36.
2:03:17right it became
2:03:1872
2:03:22100 ml
2:03:25right just a theoretical question so
2:03:277200 ml if this kind of question has
2:03:30been asked so that is the answer
2:03:33okay
2:03:34I hope everybody understood this one
2:03:36fine so that was about the burn section
2:03:40so till now we have talked about
2:03:41yesterday we have to talk about the
2:03:43trauma and today we had to talk about
2:03:45the burns please devise this topic and
2:03:47we will be uh giving some mcqs in the
2:03:51telegram group as well please join that
2:03:53group as well and we'll be updating some
2:03:55of the mcqs over there as well thank you
2:03:57so much for joining this session and I
2:04:00will see you in the next one thank you

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